Build your own Philosophy of Pain

Typically, the medical model spends a lot of time exploring what is observable in the body (by current technology) and yet fails to explain ‘how’ or ‘why’ a person continues to have pain and is left grasping for metaphors around protection or simply saying ‘somehow.’ For example, clinicians and therapists might explain that the nervous system changes to be more reactive or sensitive and that somehow means a person now has daily pain. Or, they might say that a person’s past experience of trauma ‘somehow’ means you now have a life with pain. Or, if we are very creative, a combination of the two and let’s throw in some social vulnerability to add to the picture. These all ‘somehow’ combine, to mean you now have to live a life with pain.

As a clinician, I can hear my own struggles in these words, all from a place of doing my best, but was I really doing the best for the person in front of me? Was I giving them the space to explore and enquire about pain, or was I just hoping they didn’t ask me hard questions?

The ‘somehow’ gap is not just a clinical or scientific problem, it’s a philosophical one. And here’s the crucial insight: as the clinician in the relationship, I cannot fill that gap for the person in front of me. So much of the information and experience needed to bridge it is unique and private to them: their fears, their losses, their hopes, the meaning they give to their suffering.

Yet by defaulting to reductionism, reducing pain to a single mechanism in the body or blaming a single tissue, I risk offering a dangerously incomplete story. If pain is “just” a sensitised nerve or “just” an inflamed joint, then the logical solution becomes clear: remove that tissue, fix the mechanism. I squeeze what is an all-encompassing and life-shattering experience into the tiny container of ‘just the knee’ or a receptor, or a molecule.

But as humans (not only as clinicians and patients),
we know that pain has no such boundaries.

Pain penetrates everything. It affects our ability to work, care for our children, meet friends, or simply move through our world without fear. The question isn’t just what’s happening in our tissues or nervous system, it’s what’s happening in our life when we live with pain, our sense of self, our future. Medical models can tell us about nociceptors and neural pathways, but they struggle to explain why a person would wake up each morning feeling like an unwanted guest in their own body (as one person I was working with so beautifully put it).

This is where philosophy becomes healing. Not the abstract philosophy of morality or truth for all humans, but one’s own living philosophy of ‘my pain’, my morality and my truth.

When medicine says “somehow,” people, we need a framework that makes sense of the whole experience: the body-situated perceptions like tightness, or burning etc, yes, but also the emotions, the social isolation, the loss of identity and the struggle to imagine a future.

Finding and nurturing your own philosophy means asking different questions. Not just “what’s wrong with my body?” but “how can I live well despite this pain?” Not “when will it end?” but “what does this pain mean right now in the context of my life, and how do I want to respond to it?”

Your philosophy might integrate what medicine tells you about your biology with what you know about your life circumstances, your values, and what matters most to you. It might help you see that you are not just a body with painful parts, but a person navigating a complex experience. You can view your pain as something happening in your physical body without letting it completely define your lived reality.

Moving from the very understandable position of ‘needing’ medicine to relieve the burden of pain by giving meaning to it and a solution, to becoming an active participant in making meaning of your pain, can feel daunting, even frightening. It asks something of all of us that experience pain that we may not have expected to give. But it can also be profoundly transformative. It doesn’t make the pain disappear, and I want to be clear about that.

I hope that, by working with people on their own philosophy and meaning of pain in their life, we open up space for someone to feel more empowered to live with their pain. No longer solely at pain’s mercy, defined only by what hurts. Instead, to allow their full self to include this experience of pain, so they can live creatively and meaningfully alongside it, discovering what’s still possible even when pain remains.

Nurturing and holding your philosophy on your experience of pain, whether it is persistently the same every day, or dynamically moving and changing as many people’s pain does, can help you see the path forward to living well with pain.

Laura Rathbone is the founder of Pain Geeks, an online reading community where clinicians ‘explore complexity, share ideas, and grow together.’ She is a clinician, coach, and educator dedicated to sharing the science and philosophy of pain with anyone willing to dive in, from clinicians, patients, and curious minds alike. In this article she explains how developing a philosophy of pain can help bridge the gap between patient and practitioner.

To find out more, go to www.paingeeks.community

“Pain penetrates everything. It affects our ability to work, care for our children, meet friends, or simply move through our world without fear. The question isn’t just what’s happening in our tissues or nervous system, it’s what’s happening in our life when we live with pain, our sense of self, our future.”